Implementation of an electronic monitoring and evaluation system for the antiretroviral treatment programme in the Cape Winelands district, South Africa: a qualitative evaluation

BACKGROUND: A pragmatic three-tiered approach to monitor the world's largest antiretroviral treatment (ART) programme was adopted by the South African National Department of Health in 2010. With the rapid expansion of the programme, the limitations of the paper-based register (tier 1) were the catalyst for implementation of the stand-alone electronic register (tier 2), which offers simple digitisation of the paper-based register. This article engages with theory on implementation to identify and contextualise enabling and constraining factors for implementation of the electronic register, to describe experiences and use of the register, and to make recommendations for implementation in similar settings where standardisation of ART monitoring and evaluation has not been achieved. METHODS: We conducted a qualitative evaluation of the roll-out of the register. This comprised twenty in-depth interviews with a diverse sample of stakeholders at facility, sub-district, and district levels of the health system. Facility-level participants were selected across five sub-districts, including one facility per sub-district. Responses were coded and analysed using a thematic approach. An implementation science framework guided interpretation of the data. Results & DISCUSSION: We identified the following seven themes: 1) ease of implementation, 2) perceived value of an electronic M&E system, 3) importance of stakeholder engagement, 4) influence of a data champion, 5) operational and logistical factors, 6) workload and role clarity, and 7) importance of integrating the electronic register with routine facility monitoring and evaluation. Interpreting our findings through an implementation theory enabled us to construct the scaffolding for implementation across the five facility-settings. This approach illustrated that implementation was not a linear process but occurred at two nodes: at the adoption of the register for roll-out, and at implementation at facility-level. CONCLUSION: In this study we found that relative advantage of an intervention and stakeholder engagement are critical to implementation. We suggest that without these aspects of implementation, formative and summative outcomes of implementation at both the adoption and coalface stages of implementation would be negatively affected

Physical and hydrological properties of peat as proxies for degradation of South African peatlands: Implications for conservation and restoration

The physical and hydrological properties of peat from seven peatlands in northern Maputaland (South Africa) were investigated and related to the degradation processes of peatlands in different hydrogeomorphic settings. The selected peatlands are representative of typical hydrogeomorphic settings and different stages of human modification from natural to severely degraded. Nineteen transects (141 soil corings in total) were examined in order to describe peat properties typical of the distinct hydrogeomorphic settings. We studied degree of decomposition, organic matter content, bulk density, water retention, saturated hydraulic conductivity and hydrophobicity of the peats. From these properties we derived pore size distribution, unsaturated hydraulic conductivity and maximum capillary rise. We found that, after drainage, degradation advances faster in peatlands containing wood peat than in peatlands containing radicell peat. Eucalyptus plantations in catchment areas are especially threatening to peatlands in seeps, interdune depressions and unchannelled valley bottoms. All peatlands and their recharge areas require wise management, especially valley-bottom peatlands with swamp forest vegetation. Blocking drainage ditches is indispensable as a first step towards achieving the restoration of drained peatland areas, and further measures may be necessary to enhance the distribution of water. The sensitive swamp forest ecosystems should be given conservation priority

Is tibial tuberosity-trochlear groove distance an appropriate measure for the identification of knees with patellar instability?

PURPOSE - Tibial tuberosity-trochlear groove distance (TT-TG) has been regarded as a useful tool for establishing therapeutic choices for patellar instability. Recently, it has been shown that TT-TG negatively correlated with the quadriceps angle, suggesting that if used individually, neither provide a valid measure of instability. This study aimed to compare TT-TG distance between both knees in patients with unilateral instability to assess whether this measurement is a decisive element in the management decisions for patellar instability. METHODS - Sixty-two patients (18 male and 44 female), reporting to a specialist patella clinic for recurrent unilateral patellar instability, were included in the study. Patients underwent bilateral long leg computed tomography scan to determine TT-TG distance in both knees. Tibial TT-TG in symptomatic and asymptomatic knees in the same individual was compared statistically. RESULTS - Mean TT-TG distance in the symptomatic knee was 16.9 (±4.9) mm, compared to 15.6 (±5.6) mm in the asymptomatic knee. Tibial TT-TG was not significantly different between stable and unstable knees (n.s.). CONCLUSIONS - The lack of difference in TT-TG distance between stable and unstable knees suggests that TT-TG distance alone may not be a decisive element in establishing therapeutic choices for patellar instability. It should, therefore, be interpreted with caution during clinical evaluations. LEVEL OF EVIDENCE: II

Is tibial tuberosity-trochlear groove distance an appropriate measure for the identification of knees with patellar instability?

PURPOSE - Tibial tuberosity-trochlear groove distance (TT-TG) has been regarded as a useful tool for establishing therapeutic choices for patellar instability. Recently, it has been shown that TT-TG negatively correlated with the quadriceps angle, suggesting that if used individually, neither provide a valid measure of instability. This study aimed to compare TT-TG distance between both knees in patients with unilateral instability to assess whether this measurement is a decisive element in the management decisions for patellar instability. METHODS - Sixty-two patients (18 male and 44 female), reporting to a specialist patella clinic for recurrent unilateral patellar instability, were included in the study. Patients underwent bilateral long leg computed tomography scan to determine TT-TG distance in both knees. Tibial TT-TG in symptomatic and asymptomatic knees in the same individual was compared statistically. RESULTS - Mean TT-TG distance in the symptomatic knee was 16.9 (±4.9) mm, compared to 15.6 (±5.6) mm in the asymptomatic knee. Tibial TT-TG was not significantly different between stable and unstable knees (n.s.). CONCLUSIONS - The lack of difference in TT-TG distance between stable and unstable knees suggests that TT-TG distance alone may not be a decisive element in establishing therapeutic choices for patellar instability. It should, therefore, be interpreted with caution during clinical evaluations. LEVEL OF EVIDENCE: II

‘Welc(h)omo Naledi’! What does our newest relative have to say to us?

This research is part of the project, ‘Religious Experience from an evolutionary perspective’, directed by Prof. Dr Danie Veldsman, Department Dogmatics and Christian Ethics, Faculty of Theology, University of Pretoria.The new hominin fossil called Homo naledi that was discovered 2 years ago in the Dinaledi Chamber (South Africa) was welcomed into the species of human relatives on 10 September 2015. Welcomed? Representing at least 15 individuals with most skeletal elements repeated multiple times, this is the largest assemblage of a single species of hominins yet discovered in Africa. Do, however, these bones represent a new Homo species? It is this question that I have tried to capture in my playful grammatically incorrect title ‘Welc(ho)mo Naledi’! However, it is not this question that I will endeavour to answer, but a very different theological implication. My aim in this article is definitely not to argue an opinion on the diverse question regarding the discovery of the fossil skeletons from the Dinaledi Chamber. My aim is related but different, much more modest, restricted and focused. It is to ask ‘on the other historic side’ (that is, beyond the fossil record!) of Naledi about human distinctiveness and symbolic behaviour, specifically on soteriology. Within the broader contemporary philosophical-theological discourses on anthropology and specifically the fundamental question, ‘Are we special?’, I would like ultimately to take on the intriguing theological implications for soteriology from the Naledi (and earlier) findings.http://www.hts.org.zaam2016Dogmatics and Christian Ethic